CareWatchTM

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CareWatchTM

• e-Health Data Solutions

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First..

Some History

• ? 1999 2 of the co-founders, a Health
  administrator and a nurse began brainstorming,
  recognizing the MDS data being an assessment tool
  for the Long Term Care Industry
• ? 2000 The 2 co-founders, became 3 co-founders,
  an IT specialist, believing in the vision and
  having the knowledge to develop the database as
  a Web-based Program rather than developing and
  continually updating Software
• ? 2002 Began marketing e-Health Data Solutions
• ? 2000-2004 Established the trademark CareWatchTM

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Development Theory
IT Development Expertise
Administrator - Meeting LTC Needs
Nurse Clinical Needs Perspective
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Development Theory

• ? Data facts or figures to be

PROCESSED
? Information acquired in
any manner
KNOWLEDGE
PRACTICAL UTILITY
? Useful helpful, beneficial often having
Websters New World Dictionary
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Next Step of the Development Process..
Organization of the MDS
Information
Set Time Preference
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MEETS ALL HIPAA REGULATIONS
?Defined by HIPAA as a Business
Associate ?Secured Site 128 Encryption
https secured site VeriSign
secured site
?The ability to track Who is accessing the
site What information is being accessed
When (the date and time) the information is
being accessed
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HIPAA Requirements Who (accessed the
information) Why (the purpose the
information was accessed) How often (The
number of times the site was visited )
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HIPAA REQUIREMENTS Date and Time
(information was accessed information)
Page (the specific information accessed)
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CareWatchTM

• Turns MDS Assessments into an Organizational
  Asset

MDS Data Repository
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Benefits of Automated Information from the
MDS CareWatchTM

• ? Assists with MDS data accuracy
• ? A quick snapshot to Useful Information
• ? QI/QM reports graphs with drill-down
  capabilities
• ? Ability to follow and focus on problem areas
• ? Specialty analysis and watch pages

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Simplifies the Link between Wanting
To and Able To..

• ? Improve MDS Integrity
• ? Monitor Clinical Outcomes
• ? Target Residents using Longitudinal History of
  Care
• ? Understand Track Clinical Services
• ? Empower Staff in Quality Improvement
• ? Better Define Deviation from Accepted Practices
• ? Link Quality Assurance with Risk Management
• ? Assure Better Annual Facility Surveys
• ? Improve Case Mix
• ? Take More Informed Actions to Control Risk or
  Loss

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Building an Environment of Excellence
Achieving Well Being for the Residents
And Employment Satisfaction for the Staff
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The 1st Building Block.

MDS Integrity
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• The data reported must be
• Correct
• ? Mimic CMS Rules
• All fields are answered appropriately
• Information is a true picture
• Logical
• ?Within the same section
• ? Between all the sections

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Consistency Checks

• ? EXACTLY those used by CMS
• Identifies Fatal Errors
• e-HDS Logic Flags
• Is applied to EVERY MDS submitted

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Data Integrity Summary Page
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eHDS Checks.
Missed Fields..examples

• There are no values for the checklist at least
  one option must be checked 
• M6 Foot problems and Care. Options a-g and
  g being NONE OF ABOVE. If no problems apply,
  g should be checked.
• J1 Problem Conditions. Options a-p and p
  being NONE of ABOVE. If no problems apply, p
  should be checked.
• A value is required for this field. 
• K2 Height and Weight. a is height (inches)
  and b (pounds) require numbers and cannot be
  blank.
• O1 Number of Medications. Record the number
  of different medications used in the last 7 days
  enter 0 if none used.

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eHDS Checks.
Correct Informationexamples
Change in Cognitive Status
This incorrect information is reported as an

e-HDS FLAG
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eHDS Checks.
Logic Flags
Assessment Information MUST be Sound - If
I1z1, G6c OR G6d1 (If quadplegia, then must
either be lifted manually or mechanically for
transfer) Reasonable - If K1b1, then K5c1
(If swallowing problem, then mechanically
altered diet) Coherence between sections - If
I3a-e250.01, then O3gt0 (If a Diabetic,
insulin dependent, then injections must be
greater than 0)
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eHDS Checks.
More examples of Logic Flags
Bed Mobility G1aA Bed mobility
is NEVER 8, activity did not occur. If a resident
was comatose and did not participate in any
activity then. G1aA 4, TOTAL
DEPENDENCE, Full staff performance during
entire 7 days Is the Resident Restless? If
B5d Periods of restlessness (e.g. fidgeting or
picking at skin, clothing, napkins, etc frequent
position changes repetitive physical movements
or calling out is present (gt0), then. E1n
Repetitive physical movements e.g., pacing, hand
wringing, restlessness, fidgeting, picking must
also be present (gt0) Wound Infection If I2l 1,
Wound Infection then.. M5g M5h (either /both)
application of dressing and/or medication
applied (1)
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Logic Flag Resolutions Provides Suggestions to

• ? review the resident assessment
• ? review the plan of care
• ? discuss with the care team
• ? discuss with the attending physician and or the
  APN
• possible resolutions (care plan/RAP actions)
• If the Logic Flag is not applicable,

The last resolution ALWAYS states if the flag is
not applicable, documentation in the clinical
notes should support the decision and the plan of
care should reflect alternative interventions
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The 2nd Building Block.

Monitor Clinical Outcomes
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Tracks QIs QMs

• POPULATION DATA
• Over a prescribed time period
• A comparison to the State Norm

INFORMATION SPECIFIC TO OUTCOMES
INTERVENTIONS ? Distinct information about the
facilities resident population ? The frequency
of specific nursing interventions
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Provides Resident Longitudinal Data
AND identifies fields that IMPACT Health
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Provides Information On Care Interventions
Reports If Current Clinical Interventions are
Maintaining the Residents Health
Reports Unplanned Health Outcomes
With the Ability to Set Time Intervals
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The 3rd Building Block.

Clinical Services
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Maximize The
Use of Services (When Appropriate) To Improve
Case Mix
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And Track Services... To Assure Positive
Health Outcomes
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The 4th Building Block.

Risk Management
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Avoids Unplanned Health
Outcomes AND
High Cost Services
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Stabilization. Avoid
Untoward Health Outcomes

• Examples of Questions to be answered
• Is it nutritional or a physiological problem
  (fluctuations in weight)?
• - If nutritional, should a dietary supplement be
  included in the meal plan?
• -Eating/Swallowing Nursing Rehabilitation/Restorat
  ive Care need to be implemented?
• If physiological, are medical interventions
  needed?
• Need a new or increase/decrease medication?
• Is it a Mood and Behavior Issue (Depression)?

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The 5th Building Block.

Empower Staff
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Developing Appropriate Plans of Care (POC)
Service/Care Needs (Examples) ?Depressed and not
on an anti-depressant ?Occasional urinary
incontinence and not on a toileting
plan Services currently effective
(Examples) ?Taking anti-anxiety medication not
exhibiting untoward mood and/or
behavior ?Receiving nursing rehabilitation and no
ADL loss Services needing to be reassessed
(Examples) ?On nutritional supplements but
continues to lose weight ?Activity preferences
known and available, but little to no activity
involvement
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Provides CUES to Submit Change of Condition
A significant change is a decline or
improvement in a residents status that  Is not
self-limiting  Impacts more than one area of
the residents health status  Requires
interdisciplinary review and/or revision of the
care plan
Using the RAI Revised--December 2002 GUIDELINES
FOR DETERMINING SIGNIFICANT CHANGE IN RESIDENT
STATUS Emergence of a pressure ulcer at Stage
II or higher (M2a) when no pressure ulcers were
previously present at Stage II or higher
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Quick and Easily Attainable Information About.
Individual Residents
Nursing Units
AND..
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SPC CHARTS
? Identifies Areas for Quality Improvement
Projects ? Is Evidenced Based (complied directly
from MDS data) ? Alleviates the time for staff
to compile the data ? Assists with possible
causes based on the data ? After the QI
interventions are initiated - validates
effectiveness - validates ineffectiveness
re-evaluation is needed
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The QIs Hypothesizes Areas of Concern
Provides Validity to the Hypothesis
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eHDS Niche..

The Watch Pages
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The Weight Watch Table ? Identifies the
Residents losing weight ? Comparison of weight
from LAST MDS (loss last 90 days) ? Comparison
of weight from ADMISSION (total weight loss)
IN JUST OVER 1 YEAR, THE RESIDENT LOST 14 LBS!
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The Weight Watch Table Identifies fields that may
IMPACT weight
Could this weight loss have been avoided with
changes and/or new nursing interventions?
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• The Pressure Watch Table (Skin Risk Assessment)
• ? Based on The Braden Scale
• ? A Cross Walk Developed using Exactly the Same
  Categories
• ? Identifies Residents who are at Risk for Skin
  Breakdown

Develop the Care Plan to reflect the ? The High
Risk Resident ? The Residents High Risk Needs
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The Pressure Watch Table also ? Comparison of
skin assessment to LAST MDS (last 90 days)
and ? Comparison of skin assessment to
ADMISSION assessment
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The Power of Organized Useful Information
Let s begin by Exploring the Wound Watch Table
13 of the residents have 1 ulcer.Click on
1 Ulcer
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The Page identifies ALL residents with a Stage I
ulcer
Click on a Name
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The 1st Page of the Wound Watch
Provides Past Assessments ?
Risk Category ? Ulcer Progress
? Date/Type of Assessment ? Past Ulcer/Ulcer
Stages
NOTE No Admission Ulcer No Ulcer at the most
previous assessment
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The 1st Page of the Wound Watch also includes
? Types of Skin Wounds ? General Ulcer
Treatments and just a click away from..
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The Current Plan of Care Implementation
Strategies that may impact wound healing
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Results We Have Seen Thus Far

• ? Increased accuracy in MDS data
• ? Decreased time converting data into Useful
  Information
• ? Decreased time developing plans of care and.

Increased Time With Residents
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Coming Developments for eHDS

• ? CareWatch
• Continued enhancement of MDS Centric Reporting
• Communication Watch
• Psychosocial Well Being Watch
• Standard QI/QM Reports for the Enterprise
• Change of Condition Watch
• ? Product Diversification (additional services
  and charges)
• RiskWatch Occurrence and Incident Reporting
• PrescriptionWatch

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• Understanding of variation, including
  appreciation of a stable system, and some
  understanding of special causes and common causes
  of variation, are essential for management of a
  system, including management of people
• Plan, do, study, act
• Edwards Deming

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Questions